Health & safety
Before you go
Prevention is the key to staying healthy while abroad. A little planning before departure, particularly for pre-existing illnesses, will save trouble later. See your dentist before going on a long trip, carry a spare pair of contact lenses and glasses, and take your optical prescription with you. Bring medications in their original, clearly labelled containers. A signed and dated letter from your physician describing your medical conditions and medications, including generic names, is also a good idea. If carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.
Western medicine can be in short supply in Mongolia. Most medicine comes from China and Russia and the labels won’t be in English, so bring whatever you think you might need from home. Take extra supplies of prescribed medicine and divide it into separate pieces of luggage; that way if one piece goes astray, you’ll still have a back-up supply.
Insurance
If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. (Check the Lonely Planet website at www.lonelyplanet.com/travel_services for more information.)
While you may prefer a policy that pays hospital bills on the spot, rather than paying first and sending in documents later, in Mongolia the only place that might accept this is the SOS Medica clinic.
Declare any existing medical conditions to the insurance company; if your problem is pre-existing the company will not cover you if it is not declared. You may require extra cover for adventurous activities – make sure you are covered for a fall if you plan on riding a horse or a motorbike. If you are uninsured, emergency evacuation is expensive, with bills over US$100, 000 not uncommon.
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Recommended vaccinations
The World Health Organization (WHO; www.who.int) recommends that all travellers be covered for diphtheria, tetanus, measles, mumps, rubella and polio, regardless of their destination. As most vaccines don’t produce immunity until at least two weeks after they’re given, visit a physician at least six weeks before departure. Specialised travel-medicine clinics are your best source of information; they stock vaccines and will be able to give specific recommendations for you and your trip. This is especially important for children and pregnant women. Ask your doctor for an International Certificate of Vaccination (otherwise known as the yellow booklet), which will list all of the vaccinations you have received, and take it with you.
Internet resources
There is a wealth of travel health advice on the internet. The WHO publishes a superb book called International Travel & Health, which is revised annually and is available online at no cost at www.who.int/ith. Another website of general interest is MD Travel Health at www.mdtravelhealth.com, which provides complete travel health recommendations for every country and is updated daily.
Further reading
Lonely Planet’s Healthy Travel Asia & India is a handy pocket size and packed with useful information including pre-trip planning, emergency first aid, immunisation and disease information, and what to do if you get sick on the road. Other recommended references include Traveller’s Health by Dr Richard Dawood and Travelling Well by Dr Deborah Mills (www.travellingwell.com.au). Lonely Planet’s Travel with Children is useful for families.
Required & recommended vaccinations
The WHO recommends the following vaccinations for travel to Mongolia:
Adult Diphtheria & Tetanus Single booster recommended if none in the previous 10 years. Side effects include sore arm and fever.
Hepatitis A Provides almost 100% protection for up to a year; a booster after 12 months provides at least another 20 years’ protection. Mild side effects such as headache and sore arm occur with some people.
Hepatitis B Now considered routine for most travellers, it provides lifetime protection for 95% of people. Immunisation is given as three doses over six months, though a rapid schedule is also available, as is a combined vaccination for Hepatitis A. Side effects are mild and uncommon, usually headache and sore arm.
Measles, Mumps & Rubella (MMR) Two doses of MMR are recommended unless you have had the diseases. Occasionally a rash and flu-like illness can develop a week after receiving the vaccine. Many young adults need a booster.
Typhoid Recommended unless your trip is less than a week. The vaccine offers around 70% protection, lasts for two to three years and comes as a single dose. Tablets are also available, although the injection is usually recommended as it has fewer side effects. A sore arm and fever may occur.
Varicella If you haven’t had chickenpox discuss this vaccination with your doctor.
The following are recommended for long-term travellers (more than one month) or those at special risk:
Influenza A single jab lasts one year and is recommended for those over 65 years of age or with underlying medical conditions such as heart or lung disease.
Japanese B Encephalitis Involves a series of three injections with a booster after two years. Recommended if spending more than one month in rural areas in the summer months.
Pneumonia A single injection with a booster after five years is recommended for all travellers over 65 years of age or with underlying medical conditions that compromise immunity, such as heart or lung disease, cancer or HIV.
Rabies Three injections are required. A booster after one year will then provide 10 years’ protection. Side effects are rare – occasionally headache and sore arm.
Tuberculosis (TB) A complex issue. High-risk adult long-term travellers are usually recommended to have a TB skin test before and after travel, rather than a vaccination. Only one vaccine is given in a lifetime. Children under five spending more than three months in China and/or Mongolia should be vaccinated.
Dangers & annoyances
Mongolia is a reasonably safe country in which to travel, but given the infrastructure of the country, state of the economy and other development problems, you are bound to run into hiccups along the way. With a bit of patience and planning, you should be able to handle just about anything.
Scams
Professional scamming is not common; the main thing to be aware of is dodgy tour companies that don’t deliver on their promises. We’ve had letters from readers who booked tours where the promised accommodation, food and service standards fell short of expectations. It might be good to get in writing exactly what is offered, and ask about compensation if things don’t work out as planned. The riskiest tour companies are the ones operated by guesthouses and the ones that specialise in onward trips to Russia.
Theft
Petty theft is a fact of life in Ulaanbaatar and you need to stay vigilant of bag slashers and pick pockets, especially around Naadam time when muggers do brisk trade on all the starry-eyed tourists wandering about. In the countryside, keep an eye on your gear and don’t leave valuables lying around your camp site if you wander off. Lock your kit inside your jeep or hotel whenever possible (drivers do a good job of watching your stuff). When horse trekking, be wary of Mongolians who seem to be following you; they may be after your valuables or even your horses, which are easily stolen while you sleep.
In transit
Deep Vein Thrombosis (DVT)
Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility. The longer the flight, the greater the risk. The chief symptom of DVT is swelling or pain of the foot, ankle, or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and breathing difficulties. Travellers with any of these symptoms should immediately seek medical attention.
To prevent the development of DVT on long flights you should walk regularly about the cabin, contract the leg muscles while sitting, drink plenty of fluids and avoid alcohol.
Jet lag & motion sickness
To avoid jet lag (common when crossing more than five time zones) try to drink plenty of nonalchoholic fluids and eat light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.
Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for treating motion sickness. A herbal alternative is ginger.
While you're there
Availability & cost of health care
Health care is readily available in Ulaanbaatar, but choose your hospital and doctor carefully. Ordinary Mongolians won’t know the best place to go, but a reputable travel agency or top-end hotel might. The best advice will come from your embassy. Consultations cost around US$5, although SOS Medica, a reliable clinic in Ulaanbaatar with Western doctors, charges around $200. Most basic drugs are available without a prescription. Health services in the countryside are abysmal or nonexistent. Taking very small children to the countryside is therefore risky. Female travellers will need to take pads and tampons with them on a trip as these won’t be available outside the main cities.
Brucellosis
The UN Food & Agricultural Organization (FAO) reports that Mongolia is a high-risk area for brucellosis. This is a disease of cattle yaks, camels and sheep but it can also affect humans. The most likely way for humans to contract this disease is by drinking unboiled milk or eating home-made cheese. People with open cuts on their hands who handle freshly killed meat can also be infected.
In humans, brucellosis causes severe headaches, joint and muscle pains, fever and fatigue. There may be diarrhoea and, later, constipation. The onset of the symptoms can occur from five days to several months after exposure, with the average time being two weeks.
Most patients recover in two or three weeks, but people can get chronic brucellosis, which recurs sporadically for months or years and can cause long-term health problems. Fatalities are rare but possible.
Brucellosis is a serious disease which requires blood tests to make the diagnosis. If you think you may have contracted the disease seek medical attention, preferably outside Mongolia.
Bubonic plague
This disease (which wiped out one-third of Europe during the Middle Ages) makes an appearance in remote parts of Mongolia in late summer. Almost 90% of reported cases occur in August and September.
The disease (also known as the Black Plague) is normally carried by marmots, squirrels and rats and can be transmitted to humans by bites from fleas that make their home on the infected animals. It can also be passed from human to human by coughing. The symptoms are fever and enlarged lymph nodes. The untreated disease has a 60% death rate, but if you get to a doctor it can be quickly treated. The best drug is the antibiotic streptomycin, which must be injected intramuscularly, but it is not available in Mongolia. Tetracycline is another drug that may be used.
During an outbreak, travel to infected areas is prohibited, which can greatly affect overland travel. All trains, buses and cars travelling into Ulaanbaatar from infected areas are also thoroughly checked when an outbreak of the plague has been reported, and vehicles are sprayed with disinfectant.
Hepatitis
This is a general term for inflammation of the liver. It is a common disease worldwide. The symptoms are similar in all forms of the illness, and include fever, chills, headache, fatigue, aches and pains and feelings of weakness, followed by loss of appetite, nausea, vomiting, abdominal pain, dark urine, light-coloured faeces, jaundiced (yellow) skin and yellowing of the whites of the eyes. People who have hepatitis should avoid alcohol for some time after the illness, as the liver needs time to recover.
Hepatitis A is transmitted by contaminated food and drinking water. You should seek medical advice, but there is not much you can do apart from resting, drinking lots of fluids, eating lightly and avoiding fatty foods. Hepatitis E is transmitted in the same way as hepatitis A; it can be particularly serious in pregnant women.
Hepatitis B is endemic in Mongolia. It is spread through contact with infected blood, blood products or body fluids. The symptoms of hepatitis B may be more severe than type A and the disease can lead to long-term problems such as chronic liver damage, liver cancer or long-term carrier state. Hepatitis C and D are spread in the same way as hepatitis B and can also lead to long-term complications.
There are vaccines against hepatitis A and B, but there are currently no vaccines against the other types of hepatitis.
Rabies
In the Mongolian countryside, family dogs are often vicious and can be rabid; it is their saliva that is infectious. Any bite, scratch or even a lick from an animal should be cleaned immediately and thoroughly. Scrub with soap and running water, and then apply alcohol or iodine solution. Medical help should be sought promptly to receive a course of injections to prevent the onset of the symptoms and death. The incubation period for rabies depends on where you’re bitten. On the head, face or neck it’s as little as 10 days, whereas on the legs it’s 60 days.
Sexually transmitted diseases (STDs)
The most common STDs in Mongolia include herpes, syphilis, gonorrhoea and chlamydia. People carrying these diseases often have no signs of infection. Condoms will prevent gonorrhoea and chlamydia but not syphilis or herpes. If after any sexual encounter you develop any rash, lumps, discharge or pain when passing urine seek immediate medical attention. If you have been sexually active during your travels, have an STD check upon your return.
Tuberculosis (TB)
TB is a bacterial infection usually transmitted from person to person by coughing but which may be transmitted through consumption of unpasteurised milk. Milk that has been boiled is safe to drink, and the souring of milk to make yogurt or cheese also kills the bacilli. Travellers are usually not at great risk as close household contact with an infected person is usually required before the disease is passed on. You may need to have a TB test before you travel as this can help diagnose the disease later if you become ill.
Traveller’s diarrhoea
To prevent diarrhoea, avoid tap water unless it has been boiled, filtered or chemically disinfected (with iodine tablets), and steer clear of ice. Only eat fresh fruits or vegetables if cooked or peeled, and be wary of dairy products that might contain unpasteurised milk. Eat food that is hot through and avoid buffet-style meals.
If you develop diarrhoea, be sure to drink plenty of nonalcoholic fluids, preferably an oral rehydration solution (eg Dioralyte). A few loose stools don’t require treatment, but if you start having more than four or five a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrhoeal agent (such as Loperamide). If diarrhoea is bloody, persists for more than 72 hours or is accompanied by fever, shaking, chills or severe abdominal pain you should seek medical attention.
Giardiasis is a parasite that is relatively common in travellers. Symptoms include nausea, bloating, excess gas, fatigue and intermittent diarrhoea. ‘Eggy’ burps are often attributed solely to giardiasis, but may not be specific to giardiasis. The parasite will eventually go away if left untreated, but this can take months. The treatment of choice is tinidazole; metronidazole is a second option.
Altitude sickness
Except in rare cases, only mountaineers will experience altitude sickness in Mongolia. Mild symptoms include headache, lethargy, dizziness, difficulty sleeping and loss of appetite. Treat mild symptoms by resting at the same altitude until recovery – usually a day or two. Paracetamol or aspirin can be taken for headaches. If symptoms persist or become worse, however, immediate descent is necessary; even 500m can help.
Heatstroke
This serious, occasionally fatal, condition can occur if the body’s heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous exposure to high temperatures and insufficient fluids can leave you vulnerable to heatstroke.
The symptoms are feeling unwell, not sweating very much (or at all) and a high body temperature. Where sweating has ceased, the skin becomes flushed and red. Victims can become confused, aggressive or delirious. Get victims out of the sun, remove their clothing and cover them with a wet sheet or towel and fan continually. Give fluids if they are conscious.
Hypothermia
In a country where temperatures can plummet to -40°C, cold is something you should take seriously. If you are trekking at high altitudes or simply taking a long bus trip across the country, particularly at night, be especially prepared. Even in the lowlands, sudden winds from the north can send the temperature plummeting.
Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. It is best to dress in layers; silk, wool and some of the new artificial fibres are all good insulting materials. A hat is important, as a lot of heat is lost through the head. A strong, waterproof outer layer is essential (and a ‘space’ blanket for emergencies if trekking). Carry basic supplies, including food containing simple sugars to generate heat quickly and fluid to drink.
Bites & stings
Bee and wasp stings are usually painful rather than dangerous. Calamine lotion or sting-relief spray will give relief and ice packs will reduce the pain and swelling. However, people who are allergic to bees and wasps may suffer severe breathing difficulties and require urgent medical care.
Mongolia has four species of venomous snakes: the Halys viper (agkistrodon halys), common European viper or adder (vipera berus), Orsini’s viper (vipera ursine) and the small taphrometaphon lineolatum. To minimise your chances of being bitten always wear boots, socks and long trousers where snakes may be present. Don’t put your hands into holes and crevices, and be careful when collecting firewood.
Bedbugs live in various places, but particularly in dirty mattresses and bedding, evidenced by spots of blood on bedclothes or on the wall. Bedbugs leave itchy bites in neat rows. Calamine lotion or a sting-relief spray may help. All lice cause itching and discomfort. They make themselves at home in your hair, your clothing, or in your pubic hair. You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice and infected clothing should then be washed in very hot, soapy water and left in the sun to dry.
Traditional medicine
Traditional medicine has made a comeback in Mongolia, after suppression during communism. Medicine often involves the use of native herbs, ground-up rock or bone, and even the swallowing of prayers written on tiny pieces of paper. Lamas are often employed to read prayers for the sick. Traditional medicine here is based on both Chinese and Tibetan practices. In Ulaanbaatar, there are traditional-medicine clinics at the Bakula Rinpoche Süm.
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